HBC Publications

The Majority's $279-Billion 'Doc Fix' Shell Game

The Democrats’ tactic for bringing health care legislation to the floor is a transparent attempt to gain credit for a Medicare reimbursement increase doctors want, while hiding its $279-billion cost. They have crafted a rule that lets them have it both ways: they can claim support for the doctors’ payment hike as part of their overall health care plan, but at the same time pretend its cost is a separate matter.

The Budget Committee’s Ranking Republican has requested a Congressional Budget Office [CBO] analysis of the health care bill if the “doc fix” were included. In the mean time, the House Budget Committee staff has developed its own estimates based on CBO figures. This analysis shows the following:

The “doc fix” by itself increases spending by $209 billion – plus $70 billion that is hidden in administrative actions by the Department of Health and Human Services [HHS] (explained below). Thus, the total cost of the “doc fix” is $279 billion.

When the “doc fix” is combined with the health care bill, the combination increases the deficit by $100 billion. Adding the $70 billion from the HHS action, the total deficit increase is $170 billion.

They would put upward pressure on overall health spending by increasing the Federal budgetary commitment to health care by $807 billion – compared with $598 billion for the health care bill alone.

They would increase the deficit in the long run. CBO had previously concluded the health legislation would “slightly reduce deficits in the second decade” because revenue would outpace spending increases. Adding the “doc fix” appears to reverse that trend: it causes a deficit increase of $33 billion in 2019, and would appear to lead to a further increase in the second decade.

The Democrats have sought to disguise these effects by adopting a rule that provides for consideration of both the health care bill and the “doc fix” – but takes them up separately. This maneuver seeks to win the political advantage of supporting the “doc fix” while hiding its substantial fiscal impact on health care legislation.